Client-Reported-Presenting Problems at an MFT Clinic

Heafner, Joy; Silva, Kerry; Tambling, Rachel B.; Anderson, Shayne R.

doi:10.1177/1066480716628581

Cited by 9 publications

(5 citation statements)

References 17 publications

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“…Understanding the level of pressure the client feels to be there as well as the source of that pressure may help the therapist understand the unique experience of the client. Asking about pressure to attend therapy may be especially salient for alliance formation in cases where trauma is present as clients presenting for therapy with trauma report greater pressure to attend therapy than clients presenting for other issues (Heafner et al, ). Such a process may make covert feelings of pressure more overt, and alleviate feelings of mistrust.…”

Section: Discussionmentioning

confidence: 99%

Pressure to Attend Therapy, Dyadic Adjustment, and Adverse Childhood Experiences: Direct and Indirect Effects on the Therapeutic Alliance in Couples Therapy

Anderson

Witting

Tambling³

et al. 2019

J Marital Family Therapy

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In this study we examine the role that pressure to attend therapy, dyadic adjustment, and adverse childhood experiences (ACEs) play in developing the therapeutic alliance. A total of 351 couples received treatment as usual at three family therapy training clinics. Participants rated predictor variables at intake and alliance at the fourth session. Results of a path analysis indicate that each partner's dyadic adjustment is directly associated with the quality of her or his own alliance. In addition, when male partners report more ACEs and pressure to attend treatment, their own alliance scores decrease. Additionally, when one partner reports feeling pressure to attend therapy, the other partner's alliance decreases. Finally, for males, there is an indirect effect of dyadic adjustment on alliance through pressure to attend therapy. These results suggest that clinicians should routinely assess relationship adjustment, how pressured each partner is feeling to attend treatment, and ACEs; as these may impact alliance quality. BACKGROUND AND SIGNIFICANCEThe therapeutic alliance is one of the most robust predictors of therapeutic outcomes across individual, couple, and family therapy (Barber et al., 2001;Friedlander, Escudero, Heatherington, & Diamond, 2011). A recent meta-analysis of the alliance-outcome link in couple and family therapy provides strong evidence for this relationship, with a medium effect size (d = 0.6; Friedlander, Escudero,Welmers-van de Poll, & Heatherington, 2018). Despite the importance of the alliance to successful therapeutic outcomes, we know surprisingly little about factors that predict successful alliance formation with couples. As a result of this knowledge gap, clinicians who hope to improve outcomes by improving the alliance have little guidance regarding how to do so, what elements of a client's individual history to pay attention to, or what elements of the client's relationship to address.

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Section: Discussionmentioning

confidence: 99%

Pressure to Attend Therapy, Dyadic Adjustment, and Adverse Childhood Experiences: Direct and Indirect Effects on the Therapeutic Alliance in Couples Therapy

Anderson

Witting

Tambling³

et al. 2019

J Marital Family Therapy

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“…The clients' presenting problems have typically been explored using categorizations and diagnostic language (e.g. Heafner et al 2016). However, for understanding the therapeutic change process, such content-based categories are of limited interest, in contrast to portraying how clients position themselves with respect to their problems (Avdi 2012(Avdi , 2016Leiman 2012).…”

Section: Introductionmentioning

confidence: 99%

Constructions of Nonagency in the Clients’ Initial Problem Formulations at the Outset of Psychotherapy

Toivonen

Wahlström

Kurri

2019

J Contemp Psychother

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This multiple case study investigated how clients construct nonagentic positions when formulating their problems in the beginning of their first psychotherapy session. The initial problem formulations of nine clients entering psychotherapy were analyzed with a detailed model drawing on discursive methodology, the 10 Discursive Tools model (10DT). We found ten problem formulation categories, each one distinguished by the tool from the 10DT model primarily used to construct nonagency. All clients gave several problem formulations from different categories and constructed nonagentic positions with a variety of discursive tools. When the resulting problem formulation categories were read in comparison with the descriptions of the client's stance at the outset of psychotherapy as presented in two change process models, the Assimilation of Problematic Experiences Sequence and the Innovative Moments Coding System, some similarities were found. However, the 10DT model brought out much variation in the client's nonagentic positioning in the formulations, forming a contrast with the more simplified presentations of the client's initial nonagency given in the change process models. Therapists should pay close attention to how clients express their sense of lost agency at the outset of psychotherapy and how this positions both the client and the therapist as future collaborators in psychotherapy.

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“…Many instruments have been validated through assessment of its psychometric properties (Losoi et al, 2013;Marques et al, 2013;Pimenta, Leal, & Maroco, 2012) and comparison with other established measurements (Barry, Folkard, & Ayliffe, 2014). One common construct of interest to clients, clinicians, and third parties is anxiety, which is one of the most frequently presented problems that clients report when they seek therapy (Heafner, Silva, Tambling, & Anderson, 2016). Not only is anxiety a common presenting problem, it is a risk factor for a variety of physical ailments including cardiovascular disease (Player & Peterson, 2011), one of the costliest public health concerns.…”

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confidence: 99%

Establishment of a reliable change index for the GAD-7

Bischoff

Anderson

Heafner

et al. 2020

Psychol. Community Health

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Aim It is increasingly important for mental healthcare providers and researchers to reliably assess client change, particularly with common presenting problems such as anxiety. The current study addresses this need by establishing a Reliable Change Index of 6 points for the GAD-7. Method Sample size included 116 online community participants using Amazon’s Mechanical Turk (MTurk) and archival data for 332 clinical participants. Participants completed measures of the GAD-7 and the MDI in 2 rounds. Using previously established cutoff scores and Jacobson and Truax’s (1991) method, we establish a Reliable Change Index which, when applied to 2 administrations of the GAD-7, indicates if a client has experienced meaningful change. Results For the GAD-7, the mean score for the clinical sample was 10.57. For the community sample at Time 1, the mean score was 4.14. A Pearson’s correlation was computed to assess the 14-28-day test-retest reliability of the GAD-7, r(110) = .87, indicating good test-retest reliability. Conclusion Using the RCI equation, this resulted in an RCI of 5.59. For practical use the RCI would be rounded to 6.

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Client-Reported-Presenting Problems at an MFT Clinic

Cited by 9 publications

References 17 publications

Pressure to Attend Therapy, Dyadic Adjustment, and Adverse Childhood Experiences: Direct and Indirect Effects on the Therapeutic Alliance in Couples Therapy

Pressure to Attend Therapy, Dyadic Adjustment, and Adverse Childhood Experiences: Direct and Indirect Effects on the Therapeutic Alliance in Couples Therapy

Constructions of Nonagency in the Clients’ Initial Problem Formulations at the Outset of Psychotherapy

Establishment of a reliable change index for the GAD-7

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